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Background: Healthcare-associated infections caused by antibiotic-resistant organisms (AROs) are a major cause of significant morbidity and mortality. To create and optimize infection prevention strategies, it is crucial to delineate the role of the environment and clinical infections. Methods: Over a 14-month period, we collected environmental samples, patient feces, and patient bloodstream infection (BSI) isolates in a newly built bone marrow transplant (BMT) intensive care unit (ICU). Samples were collected from 13 high-touch areas in the patient room and 4 communal areas. Samples were collected from the old BMT ICU, in the new BMT ICU before patients moved in, and for 1 year after patients moved in. Selective microbiologic culture was used to isolate AROs, and whole-genome sequencing (WGS) was used to determine clonality. Antibiotic susceptibility testing was performed using Kirby-Bauer disk diffusion assays. Using linear mixed modeling, we compared ARO recovery across time and sample area. Results: AROs were collected and cultured from environmental samples, patient feces, and BSI isolates (Fig. 1a). AROs were found both before and after a patient entered the ICU (Fig. 1b). Sink drains had significantly more AROs recovered per sample than any other surface area (P < .001) (Fig. 1c). The most common ARO isolates were Pseudomonas aeruginosa and Stenotrophomonas maltophila (Fig. 1d). The new BMT ICU had fewer AROs recovered per sample than the old BMT ICU (P < .001) and no increase in AROs recovered over the first year of opening (P > .05). Furthermore, there was no difference before versus after patients moved into the hospital (P > .05). Antibiotic susceptibility testing reveal that P. aeruginosa isolates recovered from the old ICU were resistant to more antibiotics than isolates recovered from the new ICU (Fig. 2a). ANI and clonal analyses of P. aeruginosa revealed a large cluster of clonal isolates (34 of 76) (Fig. 2b). This clonal group included isolates found before patients moved into the BMT ICU and patient blood isolates. Furthermore, this clonal group was initially found in only 1 room in the BMT ICU, and over 26 weeks, it was found in sink drains in all 6 rooms sampled (Fig. 2b). Conclusions: AROs are present before patients move into a new BMT ICU, and sink drains act as a reservoir for AROs over time. Furthermore, sink-drain P. aeruginosa isolates are clonally related to isolates found in patient BSIs. Overall, these results provide insight into ARO transmission dynamics in the hospital environment.
Funding: Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
À Hong Kong, plusieurs raisons expliquent qu’une réforme cohérente en droit de la famille se fait attendre depuis quelque temps déjà. Alors que dans le courant des dernières années des réformes touchant plusieurs aspects du droit de la famille avaient été engagées, peu de celles-ci ont abouti, souvent en raison de préoccupations soulevées au sein de l’Administration ou de la Législature, ou des deux. Face à ces préoccupations, le processus de réforme semble chaque fois se mettre à l’arrêt et l’on constate une absence de tout sentiment de nécessité ou d’urgence, malgré les nombreux appels provenant de différents acteurs du monde juridique et de la société civile en faveur d’une action législative. Malgré les efforts soutenus au cours des dernières années des magistrats qui par leur jurisprudence et leurs règles de pratique tentent de moderniser et d’améliorer le contenu et la pratique du droit familial, le leitmotiv de Hong Kong en 2019 a encore été pragmatique et à la pièce plutôt que représenter la mise en place d’une réforme globale du droit de la famille, comme ce chapitre montrera.
In many ways 2019 has not been a good year for Hong Kong. From June onwards the streets were taken over, weekend after weekend, for several months by large numbers of residents protesting against proposed extradition legislation that they feared would facilitate future infringement of their fundamental freedoms. Those protests developed in places into riots with running battles between some protestors and police, allegations of brutality on both sides and public institutions being damaged or shut down.
In these circumstances few governments could be criticised for failing to develop and implement a coherent programme of family law reform. In Hong Kong however there has arguably been little in the way of coherent legislative reform of family law for several years now. While the process of reform of a number of aspects of family law has been initiated over the past several years, few reforms are finalised and implemented, often due to concerns raised before either the Administration or the Legislature, or both. Once those concerns have been raised, the reform process seems to stall, with little sense of a need for urgent action, notwithstanding the myriad calls for legislative change from various quarters of the legal community and civil society.
This research was undertaken on the lands of the Wurundjeri people of the Kulin nation. We pay our respects to Elders of the past, present and emerging, and also acknowledge the generous contribution to this research made by women and their families and Victorian Aboriginal Child Care Agency (VACCA) staff. Aboriginal Cradle to Kinder (AC2K) is a home-visiting and advocacy programme focussed on promoting Aboriginal maternal and child health during both pre- and postnatal stages of parenthood which was delivered by VACCA, an Aboriginal Community Controlled Organisation. While there have been some feasibility assessments conducted on AC2K, no study to date has evaluated the impact of this programme from the perspective of neither the women nor the staff who deliver the programme. The aim of this study, therefore, was to evaluate how both the women and the staff evaluated the AC2K programme, namely the strengths, limitations and recommendations of the programme. Through consultation with VACCA, this study used a qualitative approach using interpretative phenomenological analysis to explore the processes underpinning the programme coupled with participants’ experiences of the programme. A co-design process was used in the development of interview questions, and a total of seven women and six workers participated in semi-structured interviews. The results revealed three superordinate themes across both participant groups: cultural connection (i.e. how well the programme facilitates cultural connection), system complexities (i.e. caseloads, staff turnover and child protection [CP] difficulties) and programme features (i.e. parenting enhancement and unique programme benefits). The processes, and the programme more broadly, were evaluated positively by both the women and staff who supported its delivery. Specifically, a greater connection to culture, increased parenting skills and unique programme benefits were reported. However, there were recommendations on how the programme could be further strengthened, including negotiable caseloads with the Department and improved partnership with CP. These changes can help to further improve the experiences of both the women and their workers when engaging in Aboriginal specific maternal health and well-being supports.
Mexican Americans suffer from a disproportionate burden of modifiable risk factors, which may contribute to the health disparities in mild cognitive impairment (MCI) and Alzheimer’s disease (AD).
The purpose of this study was to elucidate the impact of comorbid depression and diabetes on proteomic outcomes among community-dwelling Mexican American adults and elders.
Data from participants enrolled in the Health and Aging Brain among Latino Elders study was utilized. Participants were 50 or older and identified as Mexican American (N = 514). Cognition was assessed via neuropsychological test battery and diagnoses of MCI and AD adjudicated by consensus review. The sample was stratified into four groups: Depression only, Neither depression nor diabetes, Diabetes only, and Comorbid depression and diabetes. Proteomic profiles were created via support vector machine analyses.
In Mexican Americans, the proteomic profile of MCI may change based upon the presence of diabetes. The profile has a strong inflammatory component and diabetes increases metabolic markers in the profile.
Medical comorbidities may impact the proteomics of MCI and AD, which lend support for a precision medicine approach to treating this disease.
Working in Hong Kong, an international hub blessed with vibrant domestic and expatriate communities, family law practitioners respond to manifold enquiries oft en driven by social and technological change and different cultural expectations. How is Hong Kong's family law evolving to meet the changing needs of this dynamic, multi-faceted community?
Whilst Hong Kong's family law has responded innovatively to some of the challenges brought in recent years, perhaps most notably the Court of Final Appeal's support in LKW v. DD for a move from needs-based ancillary relief to a starting point of equal division of matrimonial property, it is also true to say that change has sometimes been more cautious. For example, consider the very carefully drawn decision of the Court of Final Appeal in W v. Registrar of Marriages on the scope for marriage by a transsexual in their reassigned gender identity.
While earlier resistance to legal recognition of same-sex relationships, parental responsibility in lieu of parental authority, and children as rights-holders rather than the ‘property’ of parents, suggests a tension between a ‘traditional’, hetero-normative, hierarchical concept of family life and a more progressive vision of family life and family law, 2018 saw key developments challenging the dominance of a ‘traditional’ family law. Nonetheless, the question remains: is the pace of change so glacial that any impact is only illusory?
LIMITED LEGAL RECOGNITION OF SAME-SEX RELATIONSHIPS
In 2018, two sets of legal proceedings, each claiming legal recognition of same sex-relationships in relation to spousal benefits, travelled through the courts.
The first case, Leung Chun Kwong v. Secretary for the Civil Service, was an appeal and cross-appeal to the Court of Appeal (CA) from the judgment of the Court of First Instance (CFI). The applicant – a Senior Immigration Officer – employed by the Civil Service and a Hong Kong permanent resident, had legally married his same-sex partner in New Zealand in 2014. Back in Hong Kong, he subsequently claimed financial spousal benefits which were denied. He then sought a judicial review of the decisions against him. The CFI found in his favour in relation to the Secretary for Civil Service's refusal to extend spousal medical and dental benefits to his same-sex husband.
Infants with CHD often experience growth failure. Ensuring optimal growth before surgery is associated with improved outcomes and has emerged as a significant cause of parental stress. Parents have reported a perceived lack of accessible feeding information for infants with CHD. To address this gap, the aim of this study was to develop feeding information to better support parents.
Materials and methods:
A search for existing material on six electronic databases and an internet search for unpublished (grey) literature on feeding information for infants with CHD were carried out. Following the development of feeding information, semi-structured interview(s) with parents/health-care professionals were completed, focusing on whether the information was easy to understand, relevant, provided sufficient information around feeding/feeding difficulties, and whether there were any information gaps. Iterative changes were made to the information following each interview. The process was completed until thematic saturation was achieved.
A total of 23 unique articles were identified of which 5 studies were included. From the grey literature, four web pages were reviewed. A total of 22 parents and 25 health-care professionals were interviewed. All parents/health-care professionals felt that the feeding information developed provided sufficient information; however, many wanted information on how to introduce complementary food, particularly if weaning was delayed.
This study describes the development of feeding information for infants with CHD. From parent interviews, gaps identified focused on the introduction of complementary foods and uncertainty regarding the feeding journey beyond surgery.
Centenarians have survived into very late life, but whether they reach very old age in good health remains unclear. The purpose of this study was to compare the cardiovascular health status and cognitive functioning of centenarians in the United States with centenarians in Japan.
Design, Setting, and Participants:
This cross-national design compared centenarians from the United States and Japan. The sample of U.S. centenarians was recruited from the Georgia Centenarian Study and included 287 centenarians. The sample of Japanese centenarians was recruited from the Tokyo Centenarian Study and included 304 centenarians.
Cognitive functioning was assessed with a mental status questionnaire, and cardiovascular disease by a health history assessment, blood pressure, and selected blood parameters.
The results suggest that Tokyo centenarians had lower disease experiences and BMI values, when compared to Georgia centenarians, but blood pressure was higher among Japanese centenarians. Lower levels of hemoglobin in Japanese centenarians and higher levels of C-reactive protein in Georgia were also found. The positive association of hypertension and albumin levels with cognitive functioning and the negative association of stroke occurrence with cognitive functioning were replicated in both countries. Differential effects were obtained for heart problems, BMI, and C-reactive protein (with positive effects for Tokyo centenarians, except for C-reactive protein).
For extremely old individuals, some markers of cardiovascular disease are replicable across countries, whereas differential effects for cardiovascular health also need to be considered in cardiovascular health.
Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands.
Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies.
Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake – absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours – were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake.
Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.
Interventions to reduce adolescents’ non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.
Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008–2012 were analysed. NDNS food items were classified as ‘non-core’ based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between ‘where’ (home, school, etc.) and ‘with whom’ (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).
Adolescents (n 884) aged 11–18 years.
Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at ‘Eateries’ (2·51; 2·14, 2·95) and 88 % higher at ‘School’ (1·88; 1·65, 2·13) compared with ‘Home’. EO with ‘Friends’ (1·16; CI 1·03, 1·31) and ‘Family & friends’ (1·21; 1·07, 1·37) contained 16–21 % more non-core food compared with eating ‘Alone’. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.
Regardless of individual characteristics, adolescents’ non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.
Conservation resources are limited, yet an increasing number of species are under threat. Assessing species for their conservation needs is, therefore, a vital first step in identifying and prioritizing species for both ex situ and in situ conservation actions. Using a transparent, logical and objective method, the Conservation Needs Assessment process developed by Amphibian Ark uses current knowledge of species in the wild to determine those with the most pressing conservation needs, and provides a foundation for the development of holistic conservation action plans that combine in situ and ex situ actions as appropriate. These assessments allow us to maximize the impact of limited conservation resources by identifying which measures could best serve those species requiring help. The Conservation Needs Assessment complements the IUCN Red List assessment, and together they provide a more holistic guide to conservation priorities and actions. Conservation Needs Assessments generate national prioritized lists of species recommended for conservation action. These can subsequently be used to assist in the development of species recovery plans and national action plans, or to inform national conservation priorities better. Additional tools that will evaluate the recommendations for ex situ rescues, to determine the best candidates for conservation breeding programmes, are currently under development.
Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.
Materials and methods
The modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.
Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.
Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
The objective of the present study was to evaluate intakes and serum levels of vitamin A, vitamin E, and related compounds in a cohort of maternal–infant pairs in the Midwestern USA in relation to measures of health disparities. Concentrations of carotenoids and tocopherols in maternal serum were measured using HPLC and measures of socio-economic status, including food security and food desert residence, were obtained in 180 mothers upon admission to a Midwestern Academic Medical Center labour and delivery unit. The Kruskal–Wallis and independent-samples t tests were used to compare measures between groups; logistic regression models were used to adjust for relevant confounders. P < 0·05 was considered statistically significant. The odds of vitamin A insufficiency/deficiency were 2·17 times higher for non-whites when compared with whites (95 % CI 1·16, 4·05; P = 0·01) after adjustment for relevant confounders. Similarly, the odds of being vitamin E deficient were 3·52 times higher for non-whites (95 % CI 1·51, 8·10; P = 0·003). Those with public health insurance had lower serum lutein concentrations compared with those with private health insurance (P = 0·05), and living in a food desert was associated with lower serum concentrations of β-carotene (P = 0·02), after adjustment for confounders. Subjects with low/marginal food security had higher serum levels of lutein and β-cryptoxanthin compared with those with high food security (P = 0·004 and 0·02 for lutein and β-cryptoxanthin). Diet quality may be a public health concern in economically disadvantaged populations of industrialised societies leading to nutritional disadvantages as well.
For this study, we adapted the Montgomery Borgatta Caregiver Burden Scale, used widely in the United States, to the Saudi Arabian context. To produce an Arabic, culturally sensitive version of the scale, we conducted semi-structured interviews with 20 Saudi family caregivers. The Arabic version of the scale was tested, and participants were asked to comment on the appropriateness of items for the construct of “caregiver burden” using the repertory grid technique and laddering procedure – two constructivist methods derived from personal construct theory. From interview findings, we examined the content of the items and the caregiver burden construct itself. Our findings suggest that the use of constructivist methods to refine constructs and quantitative instruments is highly informative. This strategy is feasible even when little is known about the investigated constructs in the target culture and further elucidates our understanding of cross-cultural variations or invariance of different versions of the scale.
Objectives: Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. Methods: Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. Results: Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13–2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11–5.29; p=.03). Conclusions: HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163–175)
In the modern era of carefully monitored renovations, construction-related Aspergillus outbreaks have decreased. We investigated an increase in clinical cultures growing Aspergillus species, determining that contamination of the mycology lab caused a pseudo-outbreak. A major construction site was appropriately sealed, but unrecognized staff traffic may have facilitated laboratory contamination.
Margaret E. Johnson, Associate Professor and Co-Director for the Center on Applied Feminism at the University of Baltimore School of Law.,
Ann C. McGinley, Professor of Law at the UNLV Boyd School of Law.
In Oncale v. Sundowner Offshore Services, Inc., the U.S. Supreme Court decided that same-sex sexual harassment was actionable as a violation of Title VII of the Civil Rights Act of 1964. Under Title VII, an employer cannot take an adverse employment action “because of sex.” In Oncale, the harassment included physical assaults of a sexual nature, including threatened rape. Importantly, the text of Title VII does not include “sexual orientation” or “gender identity” in its list of protected classes that includes race, color, religion, and national origin, in addition to sex.
As important as the Oncale ruling is for plaintiffs subjected to same-sex sexual harassment, it is also problematic. For instance, the U.S. Supreme Court did not include discrimination based on sexual orientation and gender identity as discrimination because of sex. In addition, many courts have interpreted the Court's opinion to limit the theories by which a plaintiff could prove same-sex discrimination to those specifically enumerated by the Court, thereby precluding other theories, such as gender role policing. The feminist judgment, by Professor Ann McGinley writing as Justice McGinley, seeks to correct these and other limitations of the original opinion.
THE U.S. SUPREME COURT DECISION
The facts of Oncale are set out in detail in the feminist judgment and need not be reiterated here. Writing for the U.S. Supreme Court, Justice Scalia provided in the original opinion only limited facts, citing the need for “brevity and dignity.” The facts of the majority thus state little more than that during his employment at Sundowner Offshore Inc., Oncale was forcibly subjected to “sex-related, humiliating actions” by male supervisors and coworkers.
On the legal issue, the Court began by holding that “nothing in Title VII necessarily bars a claim of discrimination ‘because of … sex’ merely because the plaintiff and the defendant … are of the same sex.” The Court enumerated three ways that a plaintiff could prove that same-sex harassment was because of sex and in violation of Title VII. First, the plaintiff could raise the inference of sex discrimination if the harasser was homosexual, making the harassment motivated by desire.